Apparatus and method for treating a fracture of a bone

ABSTRACT

An apparatus and method for treating a fracture of a bone is provided. A bone suture assembly includes a first bone plate positioned proximate to the bone. A suture is positioned through the first bone plate and across the fracture of the bone to thereby stabilize the fracture. A method of treating a fracture of a bone includes positioning at least one suture anchor proximate to the bone and positioning at least one bone plate between at least one suture anchor and the bone. The method also includes moving at least one suture across the fracture of the bone and through at least one bone plate, attaching at least one suture to at least one suture anchor, and tensioning at least one suture to stabilize the fracture of the bone.

CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application is a continuation of U.S. patent applicationSer. No. 09/835,473 filed Apr. 16, 2001. The aforementioned applicationSer. No. 09/835,473 is itself a continuation of U.S. patent applicationSer. No. 09/532,942 filed Mar. 22, 2000, now U.S. Pat. No. 6,238,395.The aforementioned application Ser. No. 09/532,942 is itself acontinuation of U.S. patent application Ser. No. 09/363,707 filed Jul.29, 1999, now U.S. Pat. No. 6,045,551. The aforementioned applicationSer. No. 09/363,707 is itself a continuation-in-part of U.S. patentapplication Ser. No. 09/323,488 filed Jun. 1, 1999, now U.S. Pat. No.6,117,160. The aforementioned application Ser. No. 09/323,488 is itselfa continuation of U.S. patent application Ser. No. 09/019,977 filed Feb.6, 1998, now U.S. Pat. No. 5,921,986. The benefit of the earlier filingdates of the aforementioned applications and patents is claimed.

BACKGROUND OF THE INVENTION

[0002] The present invention relates to a new and improved method andapparatus for securing sections of a fractured bone and/or securing bodytissue to bone.

[0003] When a bone is broken or fractured, it is necessary to presssections of the bone on opposite sides of the fracture together in orderto promote healing of the bone. Bone screws have been used with orwithout metal plates to hold the sections of the fractured bone againstmovement relative to each other. In addition, it has been suggested thatavulsion fractures could be treated by using wire sutures betweensections of bone in a matter similar to that disclosed in U.S. Pat. No.5,474,554. It has also been suggested that an anchor could be retainedin a bone is a manner disclosed in U.S. Pat. Nos. 5,527,343 and5,534,012.

SUMMARY OF THE INVENTION

[0004] The present invention relates to a method of securing sections ofa fractured bone. Sections of a fractured bone are held against movementrelative to each other.

[0005] In accordance with one aspect of the present invention, there isprovided a bone suture assembly for treating a fracture of a bone. Thebone suture assembly includes a first bone plate positioned proximate tothe bone and a suture positioned through the first bone plate and acrossthe fracture of the bone to thereby stabilize the fracture. The sutureassembly may include a second bone plate positioned proximate to thebone generally opposite the first bone plate. The suture may bepositioned through the second bone plate to stabilize the fracture. Thesuture assembly may also include a passage through the bone and acrossthe fracture, wherein the suture is disposed within the passage. Thepassage may be nonlinear and may include a tubular member. The suturemay be disposed within the tubular member.

[0006] Furthermore, the bone suture assembly may include at least onefastener to hold the first bone plate to the bone. At least one fastenermay extend across the fracture of the bone and may extend through thebone and through the second bone plate. At least one fastener may alsoinclude a screw and nut. Additionally, the suture assembly may include atubular member in the bone positioned across the fracture, and thesuture may be disposed within the tubular member. The tubular member maybe packed with bone particles or bone osteoinductive protein.

[0007] In accordance with another aspect of the present invention, thebone suture assembly includes a first suture anchor positioned proximateto the bone, a first bone plate positioned between the first sutureanchor and the bone, and a suture positioned across the fracture of thebone to stabilize the fracture. The suture has a first end portiondisposed through the bone plate and attached to the first suture anchor.The suture assembly may also include a second suture anchor positionedproximate to the bone generally opposite the first suture anchor. Thesecond suture anchor may be attached to a second end portion of thesuture.

[0008] Moreover, the bone suture assembly may include a second boneplate positioned between the second suture anchor and the bone. Thesuture assembly may also include a passage through the bone and acrossthe fracture, wherein the suture is disposed within the passage. In thepresent invention, the first and second suture anchors may be sutureretainers which may have deformable material to hold the sutureretainers to the suture.

[0009] In accordance with still another aspect of the present invention,a method for treating a fracture of a bone is provided. The methodincludes positioning at least one suture anchor proximate to the bone,positioning at least one bone plate between at least one suture anchorand the bone, and moving at least one suture across the fracture of thebone and through at least one bone plate. The method also includesattaching at least one suture to at least one suture anchor andtensioning at least one suture to stabilize the fracture of the bone. Atleast one suture anchor may be a suture retainer.

[0010] In addition, the method may include fastening at least one boneplate to the bone with at least one screw. At least one screw may have alength less than the diameter of the bone, and at least one screw mayhave a length greater than the diameter of the bone. At least one screwmay include at least one nut, and at least one screw may extend acrossthe fracture of the bone.

[0011] Furthermore, the method may include forming at least one passagethrough the bone and moving at least one suture through at least onepassage. Also, at least one suture attached to at least one sutureanchor may be moved through at least one passage. The method may alsoinclude changing the orientation of at least one suture anchor from afirst to a second configuration thereby causing at least one sutureanchor to become proximate to the bone and impassable through at leastone passage. Finally, the method may include tensioning at least onesuture between at least two suture anchors to stabilize the fracture ofthe bone.

BRIEF DESCRIPTION OF THE DRAWINGS

[0012] The foregoing and other features of the invention will becomemore apparent upon a consideration of the following description taken inconnection with the accompanying drawings wherein:

[0013]FIG. 1 is a schematic illustration of a bone having a fracturewhich has been treated with sutures and suture anchors;

[0014]FIG. 2 is an enlarged fragmentary schematic sectional view of aportion of the bone of FIG. 1 and illustrating the manner in which asuture extends across the fracture and interconnects suture anchors onopposite sides of the fracture;

[0015]FIG. 3 is a schematic illustration, generally similar to FIG. 2,illustrating the manner in which a suture retainer is used to maintaintension in a suture which extends across a fracture to a suture anchor;

[0016]FIG. 4 is a schematic illustration, generally similar to FIGS. 2and 3, illustrating the manner in which body tissue is connected with abone using a suture and suture anchors;

[0017]FIG. 5 is a schematic illustration, generally similar to FIGS.2-4, illustrating the manner in which a suture extends between sutureanchors through a nonlinear passage;

[0018]FIG. 6 is a schematic illustration, generally similar to FIG. 5,illustrating the manner in which a suture extends between a sutureanchor and a suture retainer through a nonlinear passage;

[0019]FIG. 7 is a schematic illustration depicting a bone which has beenfractured in such a manner as to have a bone fragment connected with thebone by muscle or other fibrous tissue;

[0020]FIG. 8 is a schematic illustration depicting the manner in whichthe bone fragment of FIG. 7 is connected to the bone by a suture and apair of suture anchors;

[0021]FIG. 9 is a schematic illustration depicting the manner in which abone fragment is connected with a bone by a suture which extends betweenan anchor within the bone and an anchor which engages the bone fragment;

[0022]FIG. 10 is a schematic illustration, generally similar to FIGS.2-4, illustrating in the manner in which plates and rigid fasteners areused in association with a suture and anchors to treat a bone fracture;

[0023]FIG. 11 is a schematic illustration depicting the manner in whicha thin elongated member is moved through bone and the manner in which adrill is moved along the thin elongated member to enlarge a passageformed in the bone by the thin elongated member;

[0024]FIG. 12 is a schematic illustration depicting the manner in whichan anchor is moved through a passage in the drill of FIG. 11 after thethin elongated member has been removed from the passage in the drill;

[0025]FIG. 13 is a schematic illustration, generally similar to FIG. 2,illustrating the manner in which a tubular member is positioned in apassage in the bone;

[0026]FIG. 14 is a schematic illustration, generally similar to FIG. 5,illustrating the manner in which tubular members are positioned in anonlinear passage in a bone; and

[0027]FIG. 15 is a schematic illustration, generally similar to FIG. 3,illustrating the manner in which a suture retainer is used with atubular member which is positioned in a passage in a bone.

DETAILED DESCRIPTION OF THE INVENTION

[0028] A bone 20 which has been fractured is illustrated in FIG. 1. Thebone 20 is divided into two sections 22 and 24 by a fracture 26.Opposite side surfaces 28 and 30 of the fracture 26 are pressed togetherby bone suture assemblies 32.

[0029] It should be understood that the bone suture assemblies 32 may beutilized in the treatment of any one of many different types offractures. The fractures may or may not result in the formation of oneor more bone fragments. In FIG. 1, the bone suture assemblies 32 havebeen illustrated as interconnecting sections 22 and 24 of a completebone fracture of the spiral type. However, the bone suture assemblies 32could be utilized to connect a fragment of a bone to the main portion ofthe bone from which the fragment was broken off.

[0030] Each of the bone suture assemblies 32 has the same construction.However, the bone suture assemblies 32 could have differentconstructions if desired. The construction of one of the identical bonesuture assemblies 32 is illustrated in FIG. 2.

[0031] The bone suture assembly 32 (FIG. 2) includes a flexible suture38 which extends across the fracture 26. The suture 38 is disposed in astraight cylindrical passage 40 which extends diametrically across agenerally cylindrical portion of the bone 20. The passage 40 extendsthrough hard compact tissue of an outer layer 42 of the bone and throughspongy or cancellous bone tissue 44 which is enclosed by the hard outerlayer. Although the passage 40 has a linear configuration, the passagecould have a nonlinear configuration if desired.

[0032] The suture 38 extends between a first suture anchor 50 disposedon one side of the fracture 26 and a second suture anchor 52 disposed onthe opposite side of the fracture. Tension is maintained in the suture38 to press the suture anchors 50 and 52 against opposite sides of thebone 20 with a predetermined force. This force presses the side surfaces28 and 30 of the fracture 26 firmly together to promote healing of thefracture. If desired, buttons or other force distributing members couldbe provided between the anchors 50 and 52 and the bone 20. Body tissuecould be disposed between the anchors 50 and 52 and the bone 20.

[0033] The suture 38 and/or suture anchors 50 and 52 maybe formed of anydesired natural or artificial material. For example, the suture 38 mayformed of either a polymeric material or a metal. The suture 38 may bebiodegradable. Any known suture material may be utilized to form thesuture 38.

[0034] The suture anchors 50 and 52 have the same construction. However,the anchor 50 could have a construction which is different than theconstruction of the anchor 52. The anchor 50 has a cylindrical outerside surface 56 which extends between smooth rounded end portions 58 and60. A pair of parallel cylindrical openings 64 and 66 extenddiametrically through the anchor 50. The anchor 50 is free of sharpcorners or projections to avoid cutting or abrading of body tissuedisposed adjacent to the anchor.

[0035] The suture anchor 50 is made of a biocompatible material.Suitable materials include stainless steel or titanium, cobalt chromeand other biocompatible metals. Polymeric material may also be used,suitable polymeric materials includes polyethylene, polypropylene, andbiodegradable material such as PLA and PGA. It is believed that it maybe preferred to form the suture anchors 50 and 52 from biodegradable orbioerodible copolymers. If desired, the anchor 50 could be formed ofbody material or hydrophilic materials.

[0036] It is contemplated that the anchor 50 may have any desiredconfiguration. For example, the anchor 50 could have any one of theconfigurations disclosed in U.S. Pat. No. 5,522,846 issued Jun. 4, 1996and entitled “Suture Anchor”. Alternatively, the suture anchor 50 couldhave the configuration disclosed in U.S. Pat. No. 5,534,012 issued Jul.9, 1996 and entitled “Method and Apparatus for Anchoring a Suture”.

[0037] Although the anchor 50 may have any desired configuration, thecross-sectional size of the anchor is such as to enable the anchor to bemoved through the passage 40. In addition, the length of the anchor 50is such as to enable it to span an opening at an end of the passage 40and transmit force from the suture 38 to a substantial area on the outerlayer 42 of the bone 20. It is believed that it will be preferred toform the anchor 50 in such a manner as to eliminate any sharp corners orprojections.

[0038] In the illustrated embodiment of the invention, the anchor 50 hasa cylindrical configuration. This particular anchor has an axial lengthof about two millimeters and a diameter of about one millimeter. Thelength of the anchor 50 may be approximately three times the diameter ofthe anchor. The openings 64 and 66 have a diameter of about one-halfmillimeter.

[0039] It should be understood that the foregoing dimensions have beenset forth herein for purposes of clarity of description and it iscontemplated that the size of the anchor 50 may vary as a function ofthe size of the bone being treated. Thus, relatively small anchors maybe used in association with treatment of small bones in a wrist, hand,foot or ankle of a patient. Relatively large anchors may be used inassociation with treatment of larger bones in an arm, shoulder, leg orhip of a patient. It should be understood that the bone suture assembly32 may be used in conjunction with many different bones other than thespecific bones previously mentioned.

[0040] Only a single anchor 50 or 52 has been shown at opposite ends ofthe passage 40. It is contemplated that a plurality of anchors could beprovided at each end of the passage 40. For example, a pair of separateor interconnected anchors could be provided in a manner similar to thatdisclosed in the aforementioned U.S. Pat. No. 5,534,012.

[0041] In the embodiment of the invention illustrated in FIG. 2, thesuture 38 has a pair of limbs or sections 72 and 74 which extend throughthe openings 64 and 66 in the suture anchors 50 and 52. A connectorsection 76 interconnects the two limbs 72 and 74 of the suture 38 andengages a portion of the anchor 50. A knot 78 is formed in the oppositeends of the limbs 72 and 74 to interconnect the two limbs of the suture38.

[0042] When the knot 78 is formed, a predetermined tension is present inthe limbs 72 and 74 of the suture 38. This results in the suture anchors50 and 52 being pressed firmly against the bone 20 with a predeterminedforce. This predetermined force is maintained during and after tying ofthe knot 78.

[0043] When the bone suture assembly 32 is to be used to treat thefracture 26 in the bone 20, the two sections 22 and 24 of the bone arepressed together at the fracture 26 to align the side surfaces 28 and 30of the fracture. A drill is then used to form the passage 40 whichextends diametrically through the generally cylindrical bone 20. Ofcourse, the passage 40 could be formed by the use of a tool other than adrill. If desired, the passage 40 could have a noncircularcross-sectional configuration.

[0044] Once the passage 40 has been formed in the two sections 22 and 24of the bone 20, a tubular cylindrical member is inserted into thepassage 40 and extends diametrically through the bone 20. The leadingend of the tubular cylindrical member is aligned with a circular outlet84 from the passage 40. The opposite end of the tubular member isaligned with a circular inlet 86 to the passage 40. The tubular memberhas a thin cylindrical wall which engages the sections 22 and 24 of thebone 20. A cylindrical inner side surface of the tubular member definesa passage having a diameter which is only slightly less than thediameter of the passage 40.

[0045] By inserting the tubular member into the passage 40, the portionsof the passage disposed on opposite sides of the fracture 26 aremaintained in alignment. The tubular member may be flexible to enablethe tubular member to be inserted into a nonlinear passage 40 throughthe bone 20. The tubular member may be formed of metal or a polymericmaterial. If the tubular member is formed of a polymeric material, itmay be preferred to form the tubular member from a biodegradable orbioerodible copolymer.

[0046] The suture 38 is formed into a loop which extends through theopenings 64 and 66 in the anchor 50. At this time, the suture 38 has alength which is substantially greater than the length illustrated inFIG. 2. The cylindrical anchor 50, with the suture 38 connected thereto,is then positioned in axial alignment with the tubular member whichextends through the passage 40. Thus, the anchor 50 is moved to anorientation in which a longitudinal central axis of the anchor iscoincident with the longitudinal central axis of the cylindrical passagein the tubular member which extends through the passage 40 in the bone20.

[0047] The leading end 58 of the anchor 50 is then moved into thecylindrical tubular member which forms a liner for the passage 40. Apusher member pushes the anchor 50 from an upper (as viewed in FIG. 2)end of the tubular member along the passage 40 in the bone 20 andthrough the outlet 84 from the passage. As the anchor 50 moves throughthe passage 40, the suture 38 is pulled through the passage 40 by theanchor.

[0048] The orientation of the anchor 50 is then changed from anorientation in which the longitudinal central axis of the anchor 50 isaligned with the longitudinal central axis of the passage 40 to anorientation in which the longitudinal central axis of the anchor 50extends generally perpendicular to the longitudinal central axis of thepassage 40, i.e., the orientation shown in FIG. 2. To pivot the anchor50 to the orientation shown in FIG. 2, as the anchor emerges from theoutlet 84, the suture 38 is tensioned. The combination of the tension inthe suture 38 and force applied against the trailing end 60 of theanchor by the pusher member causes the anchor to pivot about thetrailing end 60 of the anchor. The pusher member is then withdrawn andthe suture tensioned to move the anchor to the position shown in FIG. 2in a manner similar to that described in the aforementioned U.S. Pat.Nos. 5,527,343 and 5,534,012.

[0049] Although it is believed that it may be preferred to change theorientation of the anchor 50 after it has emerged from the passage 40,the anchor could be blocked from reentering the passage in other ways ifdesired. Thus, the anchor could expand after emerging from the passage40. This could be accomplished by having spring biased arms held in aretracted position by engagement of spring biased arms with the innerside surface of the tubular cylindrical member which lines the passage40. Upon emerging from the passage, the arms would move outward underthe influence of spring forces and extend radially outward beyond theedge of the exit from the passage 40. If desired, the anchor 50 could beconstructed so as to expand in a manner similar to that disclosed inU.S. Pat. No. 5,397,331 and/or U.S. Pat. No. 4,409,974.

[0050] Rather than expanding under the influence of stored energy, suchas spring force, the anchor 50 could expand by absorbing body fluids.Thus, the anchor 50 may be compressed when it moves through the passage40 and will expand and absorb body fluids after emerging from thepassage 40. It is contemplated that the anchor 50 could be constructedso as to expand in any one of the ways disclosed in U.S. patentapplication Ser. No. 08/699,553 filed Aug. 19, 1996 by Peter M. Bonuttiand entitled “Suture Anchor”.

[0051] The cylindrical tubular member is then withdrawn from the passage40. It should be understood that the cylindrical tubular member is usedto line the passage 40 in the bone 20 during movement of the anchor 50through the passage. The use of the tubular member to line the passage40 may be omitted if desired. However, if the use of the tubular memberto line the passage 40 is omitted, the anchor 50 and pusher member wouldbe exposed to the cancellous bone tissue 44 during movement of theanchor through the passage.

[0052] The limbs 72 and 74 of the suture 38 are then threaded throughopenings 64 and 66 in the second suture anchor 52. The limbs 72 and 74of the suture 38 are tensioned and the second anchor 52 is pressedagainst the outer side surface of the bone 20. While a predeterminedtension force is maintained in the limbs 72 and 74 of the suture 38, theknot 78 is tied in the suture to interconnect the two suture anchors 50and 52 with the suture 38. The suture 38 is then trimmed to the desiredlength.

[0053] Once the knot 78 has been tied between the limbs 72 and 74 of thesuture 38, the tension in the suture 38 presses the side surfaces 28 and30 of the fracture 26 together. This pressure between the side surfaces28 and 30 of the fracture 26 is maintained by the suture 38 and sutureanchors 50 and 52 until the fracture heals. It is believed that it maybe preferred to form the suture 38 and suture anchors 50 and 52 of abiodegradable material which, after the fracture 26 has healed, willdissolve in the patient's body.

[0054] The cylindrical tubular member which is inserted into the passage40 through the bone 20 performs the dual functions of lining the insideof the passage 40 and maintaining the two sections 22 and 24 of the bonein alignment. The cylindrical tubular member could have a slot formed ina side wall of the tubular member to facilitate insertion of the tubularmember into the passage 40. It is contemplated that the cylindricaltubular member could be left in the passage 40 after the bone sutureassembly 32 has been installed. If the slotted or unslotted cylindricaltubular member is to be left in the passage 40, the cylindrical tubularmember may be formed of a biodegradable or bioerodible copolymer. Whenthe cylindrical tubular member remains in the passage 40, the suture 38extends through the tubular member.

[0055] Although only a knot 78 has been shown in FIG. 2 adjacent to thesecond anchor 52, a suture retainer could be provided to further holdthe limbs 72 and 74 of the suture 38. If a suture retainer is to be usedin association with the knot 78, the suture retainer will be moved alongthe limbs of the suture 38 toward the knot before the limbs 72 and 74 ofthe suture are trimmed to the short length shown in FIG. 2. The sutureretainer would then be plastically deformed to grip the limbs 72 and 74of the suture 38. Thereafter, the suture limbs 72 and 74 would betrimmed to a desired length.

BONE SUTURE ASSEMBLY—SECOND EMBODIMENT

[0056] In the embodiment of the invention illustrated in FIG. 2, a pairof suture anchors 50 and 52 are connected with the suture 38 to maintaintension in the suture and pressure against opposite side surfaces 28 and30 of the fracture 26. In the embodiment of the invention illustrated inFIG. 3, a suture retainer is used in place of one of the suture anchors.Since the embodiment of the invention illustrated in FIG. 3 is generallysimilar to the embodiment of the invention illustrated in FIG. 2,similar numerals will be utilized to designate similar components, thesuffix letter “a” being associated with the embodiment of the inventionillustrated in FIG. 3 to avoid confusion.

[0057] A bone 20 a has sections 22 a and 24 a which are separated by afracture 26 a. The fracture 26 a has side surfaces 28 a and 30 a whichare pressed together by a bone suture assembly 32 a. A suture 38 aextends through a cylindrical passage 40 a which extends diametricallythrough the generally cylindrical bone 20 a. The suture 38 a has a pairof limbs or sections 72 a and 74 a which are connected with a sutureanchor 50 a. The suture anchor 50 a has the same construction as thesuture anchor 50 of FIG. 2.

[0058] In accordance with a feature of this embodiment of the invention,a suture retainer 92 is used in place of the suture anchor 52 of FIG. 2.The suture retainer 92 has a spherical configuration. A cylindricalpassage 94 extends through the center of the spherical suture retainer92. The sections 72 a and 74 a of the suture 38 a extend around thespherical outer side surface of the suture retainer 92. Thus, a loop isformed in each of the sections 72 a and 74 a around portions of thesuture retainer 92.

[0059] If desired, the suture retainer 92 could have a differentconfiguration. For example, the suture retainer 92 could have an oval orelliptical configuration. Although the passage 94 has a linear centralaxis, the passage could have a nonlinear central axis. If desired, aplurality of passages having the same or different configurations couldbe provided in the suture retainer 92.

[0060] After the suture 38 a has been inserted through the sutureretainer 92, in the manner illustrated schematically in FIG. 3, thesuture retainer 92 is moved along the sections 72 a and 74 a of thesuture 38 a toward the bone 20 a. The suture retainer 92 is formed asone piece of a polymeric material having a relatively low coefficientfriction. Therefore, the two sections 72 a and 74 a of the suture 30 acan readily slide along the surfaces of the suture retainer 52 a whilethe suture retainer moves toward the bone 20 a.

[0061] A predetermined tension is maintained in the sections 72 a and 74a of the suture 38 a while the suture retainer 92 is pressed against thebone 20 a. This results in the suture 38 a being pulled tightly againstthe suture anchor 50 a. The tension in the suture 38 a is effective topress the suture anchor 50 a and retainer 92 against opposite sides ofthe bone 20 a with a predetermined force.

[0062] Once the suture retainer 92 has been moved along the suture 38 aand is being pressed against the bone 20 a with a predetermined force,the suture retainer is plastically deformed to grip the sections 72 aand 74 a of the suture 38 a. An apparatus 98 for pressing the sutureretainer 92 against the bone 20 a includes a tubular cylindrical plunger102 (FIG. 3) having a cylindrical central passage through which thesections 72 a and 74 a of the suture 38 a extend. The plunger 102 isenclosed by a tubular cylindrical housing 106. The plunger 102 ispressed downward, relative to the housing 106 with a predeterminedforce, indicated by arrows 108 and 110 in FIG. 3. An annular transduceror load cell 114 provides an output indicative of the magnitude of theforce 108 and 110 with which the suture retainer 92 is pressed againstthe bone 20 a by the plunger 102.

[0063] While the sections 72 a and 74 a of the suture 38 a are beingtensioned with a predetermined force and while the plunger 102 is beingpressed against the suture retainer 92 with a predetermined force, thesuture retainer 92 is plastically deformed. To plastically deform thesuture retainer 92, a plurality of force applying or clamp members 120and 122 are pressed against the suture retainer 92 with a predeterminedminimum force, indicated schematically by arrows 126 in FIG. 3. Theforce application members 120 and 122 may have an arcuate configurationto conform to the spherical configuration of the suture retainer 92 ormay have a flat configuration. The force applied against the sutureretainer 92 by the force applying members 120 and 122 is sufficient tocause plastic deformation of the material of the suture retainer.

[0064] The force 126 is applied against the suture retainer 92 while thesuture retainer is at a temperature which is below the transitiontemperature of the biodegradable polymer which forms the suture retainer92. Thus, the suture retainer 92 is at approximately the sametemperature as the bone 20 a when the force 126 is applied against thesuture retainer. The force 126 causes the material of the sutureretainer 92 to flow and grip the sections 72 a and 74 a of the suture 38a.

[0065] Upon disengagement of the force application members 120 and 122from the suture retainer 92, the application of downward (as viewed inFIG. 3) force against the suture retainer 92 is interrupted. The upwardtensioning of the sections 72 a and 74 a of the suture 38 a is alsointerrupted. At this time, the plastically deformed suture retainer 92securely grips the two sections 72 a and 74 a of the suture 38 a tomaintain the tension in the suture 38 a. If desired, a knot may beformed between the sections 72 a and 74 a of the suture as additionalprotection against the suture working loose over an extended period oftime.

[0066] The suture retainer 92 may be formed of many different materials.However, it is believed that it will be preferred to form the sutureretainer 92 of a biodegradable polymer. One biodegradable polymer whichmay be utilized is polycaperlactone. Alternatively, the suture retainer92 could be formed of polyethylene oxide terephthalate or polybutyleneterephthalate. It is also contemplated that other biodegradable orbioerodible copolymers could be utilized.

[0067] Although it is preferred to form the suture retainer 92 of abiodegradable material, the suture retainer could be formed of amaterial which is not biodegradable. For example, the suture retainer 92could be formed of an acetyl resin, such as “DELRIN” (trademark).Alternatively, the suture retainer 92 could be formed ofpara-dimethylamino-benzenediazo sodium sulfonate, such as “DEXON”(trademark). The construction of the suture retainer 92 and the mannerin which is cooperates with the suture 38 a is the same as is disclosedin U.S. patent application Ser. No. 08/905,084 filed Aug. 1, 1997 byPeter M. Bonutti et al. and entitled “Method and Apparatus for Securinga Suture”.

[0068] The suture retainer 92 is plastically deformed to grip the limbs72 a and 74 a of the suture 38 a. However, the suture retainer 92 couldbe constructed so as to be mechanically actuated to grip the suture 38a. If desired, a combination of a mechanical gripping action and plasticdeformation could be utilized by a retainer to grip the suture 38 a.

Retaining Body Tissue Against Bone

[0069] In the embodiment of the invention illustrated in FIG. 2, a bonesuture assembly 32 is utilized to press surfaces 28 and 30 of a fracture26 together. In the embodiment of the invention illustrated in FIG. 4,the suture anchor assembly is utilized to hold body tissue againstmovement relative to a bone. Since the embodiment of the inventionillustrated in FIG. 4 is generally similar to the embodiments of theinvention illustrated in FIGS. 2 and 3, similar numerals will beutilized in association with similar components, the suffix letter “b”being associated with the numerals of FIG. 4 to avoid confusion.

[0070] A cylindrical passage 40 b extends diametrically through agenerally cylindrical bone 20 b. A bone suture assembly 32 b is utilizedto retain body tissue 132 against movement relative to the bone 20 b.The body tissue 132 may be a muscle, ligament, cartilage or other tissuewhich is to be held against movement relative to the bone 20 b.

[0071] The bone suture assembly 32 b includes a first suture anchor 50 band a second suture anchor 52 b. A suture 38 b extends through thepassage 40 b and interconnects the suture anchors 50 b and 52 b. Tensionin the suture 38 b presses the body tissue 132 against a side surfacearea on the bone 20 b. The suture 38 b has sections or limbs 72 b and 74b which extends through openings in the suture anchors 50 b and 52 b inthe manner previously explained. A knot 78 b interconnects the sections72 b and 74 b of the suture 38 b to press the suture anchor 52 b firmlyagainst the body tissue 132. Although the illustrated suture has a pairof sections 72 b and 74 b, the suture could have a single section ifdesired.

[0072] The suture anchor assembly 32 b is installed in association withthe bone 20 b and body tissue 132 in the same manner as previouslyexplained in conjunction with the embodiment of the inventionillustrated in FIG. 2. Thus, the passage 40 (FIG. 4) is formed in thebone 20 b by drilling or other methods. The body tissue 132 may beoffset to one side of the location where the passage 40 b is formedduring formation of the passage. This enables the passage 40 b to beformed in the bone 20 b without damaging the body tissue 132.

[0073] The suture anchor 50 b is moved through the passage 40 b with alongitudinal central axis of the suture anchor aligned with thelongitudinal central axis of the passage 40 b. When the suture anchor 50b emerges from the passage 40 b, the anchor is pivoted to theorientation shown in FIG. 4. Alternatively, the anchor 50 b may bemechanically expanded after emerging from the passage 40 b. Acylindrical tubular member may be used to line the passage 40 a duringmovement of the anchor 50 b through the passage in the manner previouslydescribed in connection with the embodiment of FIG. 2.

[0074] After the anchor 50 b has been moved to the position shown inFIG. 4, the body tissue 132 is positioned between the limbs 72 b and 74b of the suture 38 b. The limbs 72 b and 74 b of the suture 38 b arethen inserted through the openings in the suture anchor 52 b. While apredetermined tension is maintained in the suture 38 b, the knot 78 b istied between the limbs 72 b and 74 b of the suture. This results in thebody tissue 132 being pressed against the bone 20 b with a predeterminedforce. A button or other force distributing member may be providedbetween the suture anchor 52 b and body tissue 132 if desired.

[0075] In the embodiment of the invention illustrated in FIG. 4, twosuture anchors 50 b and 52 b are utilized to press the body tissue 132against the bone 20 b. However, a suture retainer could be substitutedfor one or more of the suture anchors 50 b or 52 b. For example, asuture retainer having the same construction and installed in the samemanner as the suture retainer 92 of FIG. 3 could be substituted for theanchor 52 b of FIG. 4. It should be understood that the suture retainersubstituted for the anchor 52 b of FIG. 4 could have any desiredconstruction. Thus, a suture retainer having the construction of any oneof the suture retainers disclosed in the aforementioned U.S. patentapplication Ser. No. 08/905,084 filed Aug. 1, 1997 by Peter M. Bonuttiet al. and entitled “Method and Apparatus for Securing a Suture” couldbe utilized in place of the anchor 52 b and/or the anchor 50 b.

[0076] When a suture retainer is used in place of the anchor 52 b, thesuture retainer applies force against the body tissue 132 to press thebody tissue against the bone 20 b. If desired, a force distributionmember could be provided between the suture retainer and the body tissue132.

[0077] Although the passage 40 b has been illustrated in FIG. 4 ashaving a linear configuration, the passage could have a nonlinearconfiguration if desired.

[0078] In the embodiment of the invention illustrated in FIG. 4, bodytissue 132 is disposed adjacent to only one side of the bone 20 b.However, if desired, body tissue could be disposed adjacent to oppositesides of the bone 20 b. The body tissue could be connected with theanchor 50 b in many different ways. For example, a separate length ofsuture could be connected with the body tissue and anchor 50 b or withthe suture 38 b adjacent to the anchor 50 b.

[0079] An alternative manner of connecting body tissue with the side ofthe bone adjacent to the anchor 50 b would be to insert the body tissuebetween the limbs 72 b and 74 b of the suture 36 b in the same manner asshown with the anchor 52 b. If this is to be done, an end portion of thebody tissue may be manually inserted between the limbs 72 b and 74 b ofthe suture 38 b. If a central portion of the body tissue is to bedisposed between the anchor 50 b and the bone 20 b, the connectorsection 76 b of the suture could be cut. One of the limbs 72 b or 74 bof the suture would then be separated from the anchor 50 b. The bodytissue would be inserted between the limbs of the suture 38. Theseparated end of the suture would then be inserted through the anchor 50b and connected with the other limb of the suture 38 b.

[0080] In the embodiment of the invention illustrated in FIG. 4, thebody tissue 132 is pressed against a bone 20 b which has not beenfractured. However, it is contemplated that the bone suture assembly 32could be utilized to perform the dual functions of pressing body tissueagainst a bone and of pressing opposite side surfaces of a fracturetogether. This would result in the body tissue being pressed against thebone 20 b in the manner illustrated in FIG. 4 and in opposite sidesurfaces of a fracture being pressed together in the manner illustratedin FIG. 2 for the opposite side surfaces 28 and 30 of the fracture 26.

Nonlinear Suture Passage

[0081] In the embodiment of the invention illustrated in FIG. 2, thepassage 40 through which the suture 38 extends has a linearconfiguration. In the embodiment of the invention illustrated in FIG. 5,the passage through which the suture extends has a nonlinearconfiguration. Since the embodiment of the invention illustrated in FIG.5 is generally similar to the embodiment of the invention illustrated inFIGS. 2-4, similar numerals will be utilized to identify similarcomponents, the suffix letter “c” being associated with the componentsof the embodiment of the invention illustrated in FIG. 5 to avoidconfusion.

[0082] A bone 20 c as a fracture 26 c which divides the bone into twosections 22 c and 24 c. Opposite side surfaces 28 c and 30 c of thefracture 26 c are pressed together by a bone suture assembly 32 c. Thebone suture assembly 32 c includes a suture 38 c which extends betweenfirst and second suture anchors 50 c and 52 c.

[0083] In accordance with a feature of this embodiment of the invention,the suture 38 c is disposed in a passage 40 c having a nonlinearconfiguration. Thus, the passage 40 c includes a first section 140 whichis skewed relative to a second section 142 of the passage 40 c. A bend144 is formed in the passage 40 c at an intersection 146 of the firstand second sections 140 and 142 of the passage 40 c. The flexible suture38 c extends around the bend 144 along a nonlinear path between thesuture anchors 50 c and 52 c. At the bend 144, the suture 38 c appliesforce against the section 24 c of the bone 20 c urging the section 24 ctoward the left (as viewed in FIG. 5). This force presses the sections22 c and 24 c of the bone 20 c firmly together at the fracture 26 c.

[0084] The suture anchors 50 c and 52 c have the same cylindricalconstruction as the suture anchors 50 and 52 in the embodiment of theinvention illustrated in FIG. 2. A knot 78 c (FIG. 5) is providedbetween limbs of the suture 38 c to maintain a desired tension in thesuture 38 c. This tension pulls the suture anchors 50 c and 52 c towardeach other. In addition, this tension presses the section 24 c of thebone 20 c firmly against the section 22 c of the bone at the fracture 26c.

[0085] The first section 140 of the passage 40 c is formed at an angleto and extends through a longitudinal central axis of the generallycylindrical bone 20 c. The second section 142 of the passage 40 c isformed in a direction perpendicular, i.e., along a radius, of thegenerally cylindrical bone 20 c. The two sections 140 and 142 of thepassage 40 c terminate in the spongy cancellous bone tissue 44 c.

[0086] When the suture assembly 32 c is to be used to treat the fracture26 c in the bone 20 c, the two sections 22 c and 24 c of the bone arepressed together at the fracture 26 c to align the side surfaces 28 cand 30 c of the fracture. A drill or other hole forming apparatus isthen used to form the first section 140 of the passage 40 c. The drillor other hole forming apparatus is then used to form the second section142 of the passage 40 c. When the second section 142 of the passage 40 cintersects the first section 140 of the passage 40 c, formation of thesection 142 of the passage 40 c is interrupted.

[0087] Once the nonlinear passage 40 c has been formed in the twosections 22 c and 24 c of the bone 20 c, a tubular cylindrical liner(not shown) is inserted into the passage 40 c. The tubular cylindricalliner may be formed by two separate tubular members which are insertedat opposite ends of the passage 40 c. Alternatively, the tubularcylindrical liner may be formed by a single flexible tubular memberwhich is inserted into the section 140 of the passage 40 c and thenmoved around the bend 144 into the section 142 of the passage 40 c. Itshould be understood that the tubular cylindrical liner for the passage40 c could be omitted if desired.

[0088] The cylindrical anchor 50 c, with the suture 38 c connectedthereto, is then positioned in axial alignment with the section 142 ofthe passage 40 c. The leading end 58 c of the anchor 50 c is then movedinto the lined section 142 of the passage 40 c. A flexible pusher memberapplies force against the trailing end 60 c of the anchor 50 c andpushes the anchor around the bend 144 and through the section 140 of thepassage 40 c.

[0089] Alternatively, a flexible wire or other member could be insertedinto the section 140 of the passage 40 c. The wire would move around thebend 144 and extend outward from the section 142 of the passage. Thewire would then be connected with the anchor 50 c and suture 38 c. Theleading end 58 c of the anchor 50 c would then be inserted into thesection 142 of the passage 40 c. Tension on the wire would pull theanchor 50 c around the bend 144 and out of the section 140 of thepassage 40 c.

[0090] Once the anchor 50 c has been moved out of the passage 40 c, thetubular liner for the passage may be withdrawn. If a one-piece tubularliner is used, it may be withdrawn from the open end of the section 142of the passage 40 c. If a two-piece liner is used, one of the pieces maybe withdrawn from the open end of the passage section 140 and slit toclear the suture 38 c. Alternatively, the slit could be formed in thepiece of the liner before it is inserted into the passage section 140.The other piece of the liner would be withdrawn from the open end of thepassage section 142. Alternatively, the tubular liner for the passage 40c may be left in place. Of course, the use of a tubular liner for thepassage 40 c may be omitted.

[0091] The suture 38 c is then threaded through openings in the sutureanchor 52 c. The suture 38 c is then tensioned and the second anchor 52c is pressed against the outer side surface of the bone 20 c. While apredetermined tension force is maintained in the suture 38 c, the knot78 c is tied.

[0092] In the illustrated embodiment of the invention, the two sections140 and 142 of the passage 40 c have a straight cylindricalconfiguration. However, it is contemplated that the sections 140 and 142of the passage 40 c could have a different configuration if desired. Forexample, the section 140 and/or 142 of the passage 40 c could have anonlinear central axis and could have a noncircular cross-sectionalconfiguration of desired.

[0093] Body tissue, corresponding to the body tissue 132 of FIG. 4 couldbe disposed between the anchor 50 c and/or 52 c and the bone 20 c.Although the suture 38 c has been illustrated as having a pair of limbsor sections which extend between the anchors 50 c and 52 c, the suture38 c could have a single limb or section if desired. The anchor 50 ccould mechanically expand, by absorbing body liquid or under theinfluence of expansion springs, after the anchor has emerged from thepassage 40 c to prevent the anchor from being pulled back through thepassage.

NONLINEAR PASSAGE—SECOND EMBODIMENT

[0094] In the embodiment of the invention illustrated in FIG. 5, thebone suture assembly 32 c associated with the nonlinear passage 40 cincludes a pair of suture anchors 50 c and 52 c. In the embodiment ofthe invention illustrated in FIG. 6, a suture retainer in substitutedfor one of the suture anchors in much the same manner as previouslydescribed in conjunction with the embodiment of the inventionillustrated in FIG. 3. Since the embodiment of the invention illustratedin FIG. 6 is generally similar to the embodiment of the inventionillustrated in FIGS. 2-5, similar numerals will be utilized to designatesimilar components, the suffix letter “d” being associated with thenumerals of FIG. 6 in order to avoid confusion.

[0095] A bone 20 d has a fracture 26 d which divides the bone into twosections 22 d and 24 d. The fracture 26 d has side surfaces 28 d and 30d which are pressed together by a bone suture assembly 32 d. The bonesuture assembly 32 d includes a suture 38 d which extends through anonlinear passage 40 d having the same construction as the nonlinearpassage 40 c of FIG. 5.

[0096] In accordance with a feature of this embodiment of the invention,the bone suture assembly 32 d includes a suture anchor 50 d having thesame construction as the suture anchor 50 of FIG. 2, and a sutureretainer 92 d having the same construction as the suture retainer 92 ofFIG. 3. The suture anchor 50 d and suture retainer 92 d maintain apredetermined tension in the suture 38 d. This results in the sutureanchor 50 d being firmly pressed against the section 24 d of the bone 20d. The suture retainer 92 d is firmly pressed against the section 22 dof the bone 20 d by the tension in the suture 38 d.

[0097] Since the passage 40 d has a nonlinear configuration, the suture38 d is effective to apply a force component to the section 24 d of thebone 20 d urging the section 24 d of the bone toward the left (as viewedin FIG. 6). This results in the surface 30 d of the fracture 26 d beingpressed firmly against the surface 28 d of the fracture.

[0098] The suture retainer 92 d is plastically deformed to grip thesuture 38 d in the same manner as previously described herein inconjunction with the suture retainer 92 of FIG. 3. However, the sutureretainer 92 d could be constructed so as to form a mechanical connectionwith the suture 38 d. If desired, a suture retainer could be substitutedfor the anchor 50 d.

[0099] Although both the suture retainer 92 d and anchor 50 d have beenillustrated in FIG. 6 as being disposed in engagement with the bone 20d, a force distributing member could be provided between the anchorand/or suture retainer and the bone. It is contemplated that bodytissue, similar to the body tissue 132 of FIG. 4, could be disposedbetween the anchor 50 d and/or the suture retainer 92 d and the bone 20d.

Tissue Tensioning with Bone Fragment Retaining

[0100] In the embodiment of the invention illustrated in FIG. 2, thefracture in a portion of a bone is treated. In the embodiment of theinvention illustrated in FIGS. 7 and 8, a fracture results in a fragmentof a bone being separated from a main portion of the bone. The bonefragment is connected with the main portion of the bone by muscle,tendon, ligament, cartilage or other fibrous body tissue. In theembodiment of the invention illustrated in FIGS. 7 and 8, the fibrousbody tissue is tensioned as the bone fragment is positioned relative tothe main portion of the bone. Since the embodiment of the inventionillustrated in FIGS. 7 and 8 is generally similar to the embodiment ofthe invention illustrated in FIGS. 2-6, similar numerals will beutilized to designate similar components, the suffix “e” beingassociated with the numerals of FIGS. 7 and 8 in order to avoidconfusion.

[0101] A bone fragment 154 is separate from a main bone 20 e (FIG. 7).The fragment 154 is connected with the main bone 20 e by fibrous bodytissue 158, i.e., muscle, tendon, ligament, cartilage, etc. The fibrousbody tissue 158 extends between the bone fragment 154 and a portion 160of the main bone 20 e. The bone fragment 154 has a side surface 28 ewith a configuration which matches the configuration of a side surface30 e of a fracture 26 e which occurred in the main bone 20 e.

[0102] In order to promote healing of the main bone 20 e, a bone sutureassembly 32 e (FIG. 8) is utilized to pull the bone fragment 154 towardthe main bone 20 e. As this occurs, the fibrous body tissue 158 istensioned and the side surface 28 e on the bone fragment 154 is pressedagainst the side surface 30 e on the main bone 20 e. The bone fragment154 is pressed firmly against the main bone 20 e by the bone sutureassembly 32 e. Thus, the gap illustrated schematically in FIG. 8,between the side surfaces 28 e and 30 e of the fracture 26 e, iseliminated and the side surfaces of the fracture are pressed firmlytogether by the bone suture assembly 32 e. If desired, the bone fragment154 may be manually pressed against the main bone 20 e before the bonesuture assembly is pulled tight.

[0103] The bone suture assembly 32 e includes a suture 38 e having limbsor sections 72 e and 74 e. The suture 38 e extends through openings in afirst suture anchor 50 e. The suture then extends into a passage 40 eformed in the bone fragment 154 and the main bone 20 e.

[0104] The passage 40 e includes a first section 140 e which extendsthrough the bone fragment 154. In addition, the passage 40 e includes asecond section 142 e which extend through the main bone 20 e. The limbsor section 72 e and 74 e of the suture 38 e extends through a secondanchor 52 e.

[0105] During installation of the bone suture assembly 32 e, the limbs72 e and 74 e of the suture 38 e are gripped by a force or tensionmeasurement device 98 e. The tension measurement device 98 e includes aload cell which measures the amount of tension applied to the limbs 72 eand 74 e of the suture 38 e.

[0106] As tension is applied to the limbs 72 e and 74 e of the suture 38e, the bone fragment 154 is pulled toward the right (as viewed in FIG.8) to move the side surface 28 e on the bone fragment into alignmentwith the side surface 30 e on the main bone 20 e. As this occurs, thefibrous body tissue 158 is stretched or tensioned. While a predeterminedforce is transmitted through the limbs 72 e and 74 e to the sutureanchor 50 e and the bone fragment 154 to firmly press the bone fragmentagainst the main bone 20 e, a knot 78 e is tied to interconnect thelimbs 72 e and 74 e. While the predetermined tension is maintained andthe knot 78 e tied, the second anchor 52 e is firmly pressed against theside surface of the main bone 20 e.

[0107] Although the passage 40 e could have a linear configuration ifdesired, in the embodiment of the invention illustrated in FIG. 8, thepassage 40 e has a nonlinear configuration. Thus, the first section 140e of the passage 40 e has a central axis which is skewed relative to acentral axis of the second section 142 e of the passage 40 e. Thisenables the flexible suture 38 e to apply force to the bone fragment 154having components urging the bone fragment rightward (as viewed in FIG.8) against the surface 30 e on the main bone 20 e and downward (asviewed in FIG. 8) to maintain the tension in the fibrous body tissue158.

[0108] When the passage 40 e is to be formed in the bone fragment 154and main bone section 20 e, a hole is drilled through the bone fragment154 to form the first section 140 e of the passage. The second portion142 e of the passage 40 e is drilled in the main bone 20 e. It should beunderstood that the passage 40 e could be formed in many different waysother than drilling. For example, a cutting tool or laser could be usedto form the passage 40 e.

[0109] The second section 142 e of the passage 40 e has a longitudinalcentral axis which is skewed at an acute angle relative to thelongitudinal central axis of the first section 140 e of the passage inthe bone fragment 154. Thus, the first portion 140 e of the passage 40 ein the bone fragment 154 has a central axis which is close to beingperpendicular to a longitudinal central axis of the main bone 20 e. Thesecond portion 142 e of the passage 40 e has a longitudinal central axiswhich is angularly offset to a substantial arc relative to thelongitudinal central axis of the main bone 20 e.

[0110] The anchor 50 e is moved through the first section 140 e of thepassage 40 e and positioned in engagement with an outer side surface ofthe bone fragment. The free ends of the limbs 72 e and 74 e of thesuture 38 e are then moved rightward (as viewed in FIG. 8) through thesecond portion 142 e of the passage 40 e. The free ends of the suture 38e are then threaded through openings in the second anchor 52 e.

[0111] After the suture 38 e has been inserted through openings in thesecond anchor 52 e, the force or tension measuring device 98 e isutilized to pull the free ends of the suture 38 e toward the right (asviewed in FIG. 8). This tension pulls the bone fragment 154 intoengagement with the main bone 20 e. The knot 78 e is tied in the freeends of the suture 38 e while the tension is maintained in the suture.

[0112] If desired, the bone suture assembly 32 e could be positionedrelative to the bone 20 e and the bone fragment 154 by moving the anchor50 e first through the second section 142 e of the passage disposed inthe main bone 20 e and then through the first section 140 e of thepassage disposed in the fragment 154. The free ends of the suture wouldthen be inserted through the second anchor 52 e. The suture 38 e wouldbe tensioned to pull the bone fragment 154 into place with the sidesurface 28 e in aligned engagement with the surface 30 e on the mainbone 20 e. The knot 78 e would then be tied while maintaining thedesired tension in the suture 38 e.

[0113] It should be understood that the anchor 52 e and knot 78 e couldbe positioned adjacent to the bone fragment 154 and the anchor 50 epositioned adjacent to the bone 20 e. Although only a single bone sutureassembly 32 e has been illustrated in FIG. 8, multiple bone sutureassemblies could be used to position the bone fragment 154 relative tothe bone 20 e.

[0114] In the embodiment of the invention illustrated in FIGS. 7 and 8,the bone suture assembly 32 e includes a pair of anchors 50 e and 52 e.If desired, a suture retainer could be substituted for either or both ofthe anchors 50 e and 52 e. Thus, a suture retainer having a constructionsimilar to the construction of the suture retainer 92 of FIG. 3 could beused in place of the second anchor 52 e. It should be understood thatthe suture retainer 92 could have the same construction as any one ofthe suture retainers disclosed in the aforementioned U.S. patentapplication Ser. No. 08/905,084 filed Aug. 1, 1997 by Peter M. Bonuttiet al. and entitled “Method and Apparatus for Securing a Suture”.

[0115] In the embodiment of the invention illustrated in FIG. 8, theanchors 50 e and 52 e are placed in engagement with the bone of fragment154 and main bone 20 e. However, it is contemplated that the anchor 50 eand/or 52 e could be positioned in engagement with body tissue otherthan bone. For example, the anchor 50 e could be positioned inengagement with a portion of the fibrous body tissue 158 to position thefibrous body tissue 158 relative to the bone fragment 154 and to moresecurely interconnect the fibrous body tissue and the bone fragment. Ifdesired, body tissue could be positioned between the anchor 52 e and themain bone 20 e.

[0116] In FIG. 8, there is a single bone fragment 154. However,fractures may occur in such a manner as to have a plurality of bonefragments. A plurality of bone suture assemblies 32 e could be utilizedto interconnect the plurality of bone fragments and the main bone.

[0117] When a fracture occurs in such a manner as to form a plurality ofbone fragments, it may be desired to use bone suture assemblies 32 e inassociation with only the larger bone fragments. If desired, a bridge orcover member could extend across the bone fragments to position the bonefragments relative to each other. One or more bone suture assemblies 32e would extend through one or more of the larger bone fragments andthrough the bridge or cover member. Force applied against the bridge orcover member by an anchor or anchors in a bone suture assembly orassemblies 32 e would urge the bridge or cover member toward the mainbone 20 e to position the smaller bone fragments relative to the largerbone fragments and main bone 20 e and to press the bone fragmentsagainst each other and against the main bone.

[0118] One or more of the anchors 50 e and 52 e could be formed of bodytissue or of material which absorbs body fluid and expands.Alternatively, one or more of the anchors 50 e or 52 e could bemechanically expanded to block movement into the passage 50 e.

Bone Fragment Retention

[0119] In the embodiment of the invention illustrated in FIG. 2, thebone suture assembly 32 extends between diametrically opposite outerside surface areas on the bone 20. This results in the first sutureanchor 50 being disposed against an outer side surface of the hard outerlayer 42 of the bone 20 (FIG. 1) and the suture anchor 52 being disposedagainst the outer side surface of the hard outer layer 42 on theopposite side of the bone. In the embodiment of the inventionillustrated in FIG. 9, one of the anchors is disposed within the boneand the other anchor is disposed outside of the bone. Since theembodiment of the invention illustrated in FIG. 9 is generally similarto the embodiment of the invention illustrated in FIGS. 2-8, similarnumerals will be utilized to identify similar components, the suffixletter “f” being associated with the numerals of FIG. 9 in order toavoid confusion.

[0120] A bone 20 f has a hard outer layer 42 f which encloses spongycancellous bone tissue 44 f. A fragment 164 has broken away from thehard outer layer 42 f. A bone suture assembly 32 f is used to positionand hold the fragment 164 in engagement with the bone 20 f. The bonesuture assembly 32 f includes a first suture anchor 50 f which isdisposed in engagement with an inner side surface 166 of the outer layer42 f of bone. A second anchor 50 f is disposed in engagement with anouter side surface 168 of the fragment 164. A suture 38 f extendsbetween the first and second anchors 50 and 52 f. The suture 38 fextends through a passage 40 f which extends across a fracture 26 f.

[0121] When the bone suture assembly 32 f is used to position thefragment 164 against the outer layer 42 f of the bone 20 f, the fragment164 is aligned with the outer layer 42 f of the bone 20 f. At this time,a side surface 172 on the fragment 164 is disposed in aligned engagementwith a side surface 174 on the bone 20 f. The two side surfaces 172 and174 were formed by breaking away of the fragment 164 from the outerlayer 42 f of the bone.

[0122] Once the fragment 164 has been aligned with the bone 20 f, thelinear passage 40 f is formed by drilling or other methods through thefragment 164 and the outer layer 42 f of bone. A cylindrical tubularmember (not shown) having a thin cylindrical side wall is then insertedthrough the passage 40 f. The first anchor 50 f is moved to anorientation in which a longitudinal central axis of the first anchor isaligned with a longitudinal central axis of the cylindrical tubularmember.

[0123] The first anchor 50 f is then moved through the cylindricaltubular member, across the fracture 26 f and into the spongy cancellousbone tissue 44. A pusher member applies force against a trailing end ofa first anchor 50 f to push the anchor through the tubular member. Whenthe leading end of the first anchor 50 f emerges from the passage 40 f,the longitudinal central axis of the first anchor is aligned with thelongitudinal central axis of the passage 40 f.

[0124] The first anchor 50 f is then pivoted through 90 degrees tochange its orientation to the orientation shown in FIG. 9. The tubularmember is then withdrawn from the passage 40 f. The free ends of thesuture 38 f are then inserted through openings in the anchor 52 f. Thesuture is tensioned to press the anchor 50 f against the inner sidesurface 166 on the outer layer 42 f of the bone 20 f. The second anchor52 f is pressed against the outer side surface 168 or the fragment 164with a predetermined force by the tension in the suture 38 f. A knot 78f is then tied in the free ends of the suture 38 f to maintain thedesired tension in the suture.

[0125] Although it is believed that it may be desired to remove thetubular member from the passage 40 f, the tubular member could be leftin the passage if desired. If the tubular member is to be left in thepassage 40 f, the tubular member may be formed of a biodegradable orbioerodible copolymer. Of course, the use of the tubular member could beeliminated if desired.

[0126] It should be understood that a suture retainer, having aconstruction similar to the construction of the suture retainer 92 ofFIG. 3, could be used in place of the second anchor 52 f if desired.Although the suture anchor 52 f has been shown in FIG. 9 as beingdisposed in direct abutting engagement with the outer side surface 168of the bone fragment 164, a layer of body tissue could be providedbetween the suture anchor 52 f and the outer side surface 168 of thebone fragment 164 to hold the body tissue against movement relative tothe bone 20 f. If desired, a plurality of bone suture assemblies 32 fcould be utilized to hold the bone fragment 164.

Use of Plates with Bone Suture Assembly

[0127] In the embodiment of the invention illustrated in FIG. 2, thesuture anchors 50 and 52 are disposed in abutting engagement with anouter side surface of a bone. In the embodiment of the inventionillustrated in FIG. 10, a pair of bone plates and rigid fasteners areused in association with a bone suture assembly. Since the embodiment ofthe invention illustrated in FIG. 10 is generally similar to theembodiment of the invention illustrated in FIGS. 2-9, similar numeralswill be utilized to designated similar components, the suffix “g” beingassociated with the numerals of FIG. 10 to avoid confusion.

[0128] A bone 20 g has sections 22 g and 24 g which are separated by afracture 26 g. In accordance with a feature of this embodiment of theinvention, a pair of plate members 184 and 186 are used in associationwith a bone suture assembly 32 g. The plate members 184 and 186 may beformed of any desired biocompatible material. Thus, the plate membersmay be formed of metal or a polymeric material. If the plate members 184and 186 are formed of polymeric material, biodegradable or bioerodiblecopolymers could be utilized.

[0129] In the illustrated embodiment of the invention, the plate members184 and 186 are rigid and are shaped to engage the bone 20 g. Ifdesired, the plate members 184 and 186 could have sufficient flexibilityto enable the plate members to be plastically deformed to theconfiguration of the bone 20 g after having been positioned inengagement with the bone.

[0130] A first suture anchor 50 g is pressed against the plate member184 by tension in a suture 38 g. The suture 38 g extends through apassage 40 g in the bone 20 g. A second anchor 52 g is pressed againstthe plate member 186 by the tension in the suture 38 g. A knot 78 g isprovided in the suture 38 g.

[0131] A pair of screws 190 and 192 extend diametrically through thebone 20 g between the plate members 184 and 186. The screws 190 and 192are engaged by nuts 196 and 198 which engage the plate member 184. Thescrews 190 and 192 and nuts 196 and 198 cooperate to press the platemembers 184 and 186 against the bone 20 g. If desired, bone sutureassemblies having the same construction as the bone suture assembly 32 gcould be substituted for the screws 190 and 192 and nuts 196 and 198 sothat the plates 184 and 186 would be held in position against the bone20 g by only the plurality of bone suture assemblies 32 g.

[0132] The screws 190 and 192 and nuts 196 and 198 may be formed of anydesired biocompatible material. Thus, the screws 190 and 192 and nuts196 and 198 may be formed of metal or a polymeric material. If thescrews 190 and 192 and nuts 196 and 198 are formed of polymericmaterial, biodegradable or bioerodible copolymers could be utilized.

[0133] In the illustrated embodiment of the invention, the screws 190and 192 extend through the bone 20 g. It is contemplated that shorterscrews could be utilized if desired. These shorter screws would haverelatively coarse bone engaging thread convolutions to hold the shortscrews and plate members 184 and 186 in place. The shorter screws wouldhave a length which is less than diameter of the bone 20 g.

[0134] In the illustrated embodiment of the invention, the bone sutureassembly 32 g extends through a linear passage 40 g. If desired, thepassage 40 g could have a nonlinear configuration. If bone sutureassemblies 32 g are substituted for the screws 190 and 192 and nuts 196and 198, some of the bone suture assemblies could extend through linearpassages while other bone suture assemblies extend through nonlinearpassages.

Installation Method

[0135] In the embodiment of the invention illustrated in FIG. 2, thepassage 40 is formed in the bone 20 by any desired method. A thin walledcylindrical tubular member is then inserted into the passage and thefirst suture anchor 50 moved through the thin walled member. In theembodiment of the invention illustrated in FIGS. 11 and 12, a cannulateddrill is used to drill a passage through a bone and to guide movement ofthe first anchor through the bone. Since the embodiment of the inventionillustrated in FIGS. 11 and 12 is generally similar to the embodimentsof the invention illustrated in FIGS. 2-10, similar numerals will beutilized to identify similar components, the suffix “h” being associatedwith the numerals in FIGS. 11 and 12 to avoid confusion.

[0136] A bone 20 h has a fracture (not shown). When the fracture is tobe treated with a bone suture assembly 32 h (FIG. 12), a thin elongatedcylindrical member or K-wire 204 is first inserted through the bone 20h. This may be done by rotating the thin elongated member 204 with adrill drive mechanism in the manner indicated by an arrow 206 in FIG.11. The drill drive mechanism is provided with a passage which extendsthrough a drive shaft for the mechanism. While the thin elongated member204 is being rotated by the drill drive mechanism, the K-wire extendsthrough the passage in the drill drive mechanism.

[0137] As the thin elongated member 204 is rotated by the drill drivemechanism, it is pressed against the bone 20 h. As the thin elongatedmember 204 is rotated, in the manner indicated by the arrow 206 in FIG.11, the thin elongated member is moved diametrically through thegenerally cylindrical bone 20 h until the leading end of the thinelongated member 204 extends from the opposite side of the bone. Thus,the thin elongated member 204 is moved through the hard outer layer 42 h(FIG. 12) at one side of the bone 20 h, through the spongy or cancellousbone tissue 44 h, and through the hard outer layer at the diametricallyopposite side of the bone. When this has been done, the thin elongatedmember 204 will extend across the fracture in the bone.

[0138] The drill drive mechanism is then disengaged from the thinelongated member 204. A cannulated drill 210 is moved axially along thethin elongated member until the leading end portion 212 of the drill 210engages the bone 20 h (FIG. 11). The drill 210 is then gripped by thedrill drive mechanism.

[0139] While the thin elongated member 204 remains stationary, the drill210 is rotated about the thin elongated member in the manner indicatedby an arrow 214 in FIG. 11. As the drill 210 is rotated about thestationary thin elongated member 204, the drill is moved axially intothe bone 20 h. As this occurs, the leading end 212 of the drill enlargesthe hole or passage formed in the bone 20 h by the thin elongated member204. The drill 210 is moved along the thin elongated member 204 untilthe drill extends diametrically across the bone 20 h. This movement ofthe drill 210 is guided by engagement of the thin elongated member 204with a side wall of a cylindrical passage 218 which extends axiallythrough the drill 210. Movement of the drill 210 through the bone 20 hforms a passage 40 h which extends through a fracture in the bone.

[0140] Once the drill 210 has been moved diametrically through thegenerally cylindrical bone 20 h (FIG. 12), the thin elongated member 204is withdrawn from the drill. This leaves an open cylindrical passage 218extending through the drill 210 and across the bone 20 h. The passage218 has a diameter which is just slightly greater than the diameter of acylindrical first anchor 50 h of the bone suture assembly 32 h. Thecylindrical first anchor 50 h is axially aligned with the passage 218 inthe drill 210, in the manner shown in FIG. 12. At this time, the suture38 h has been inserted through openings in the first anchor 50 h andsuture limbs or sections 72 h and 74 h extend away from the first anchor50 h, in the manner indicated schematically in FIG. 12.

[0141] A cylindrical pusher member 222 is axially aligned with the firstanchor 50 h and the passage 218 through the drill 210. The pusher member222 is utilized to push the first anchor 50 h through the drill 210 tothe far side of the bone 20 h.

[0142] As the first suture anchor 50 h emerges from the passage 28 inthe drill 210, the anchor is pivoted through ninety degrees. Thispivotal movement changes the orientation of the anchor 50 h from anorientation in which the longitudinal central axis of the anchor 50 h isaligned with the longitudinal central axis of the passage 218 and drill210 to an orientation in which a longitudinal central axis of thecylindrical anchor 50 h extends perpendicular to the longitudinalcentral axis of the passage and drill. The manner in which the anchor 50h is pivoted is the same as is described in the aforementioned U.S. Pat.Nos. 5,527,343 and 5,534,012.

[0143] The pusher member 222 is then withdrawn from the drill 10 and thedrill is withdrawn from the passage formed through the bone 20 h. Asthis occurs, the suture 38 h is tensioned to hold the anchor 50 h inplace against the bone 20 h. The drill 210 is then disengaged from thesuture 38 h. The free limbs 72 and 74 of the suture 38 h are theninserted through a second anchor corresponding to the anchor 52 in FIG.2. While a predetermined tension is maintained in the suture 38 h, thesuture is tied to hold the second suture anchor, corresponding to thesuture anchor 52 in FIG. 2, against the bone 20 h on a side of the boneopposite from the anchor 50 h.

[0144] In the foregoing description, the drill 210 has been a rigiddrill which has been used to form a linear passage to the bone 20 h.However, it is contemplated that a flexible drill could be utilized todrill a passage through the bone. If this was done, the drill could beguided in such a manner as to form a nonlinear passage in the bone.

[0145] The foregoing description of how the passage 40 h is formed hasbeen in conjunction with a bone 20 h having a fracture similar to thefracture 26 of FIG. 2. However, it is contemplated that the thinelongated member 204 and drill 210 could be used to form a passage in abone which has not been fractured (FIG. 4). The thin elongated member204 and 210 could be used to form a passage which extends only part waythrough a bone (FIG. 9).

[0146] In the description of the embodiments of the inventionillustrated in FIGS. 1-12, the suture 38 (FIG. 2) has a pair of limbs orsections 72 and 74. It is contemplated that the suture 38 could haveonly a single limb which would be connected at one end with the firstanchor 50 and at the opposite end with the second anchor 52. This singlelimb could either be tied off at the second anchor 52 or gripped by asuture retainer, similar to the suture retainer 92 of FIG. 3.

[0147] In the embodiments of the invention illustrated in FIGS. 1-12,the suture 38 has been formed separately from the first suture anchor50. It is contemplated that the first suture anchor 50 could be formedas one piece with the suture 38. For example, the suture and anchorcould be formed as one piece in a manner similar to that disclosed inU.S. Pat. No. 4,669,473 or in U.S. Pat. No. 4,741,330.

[0148] The anchors 50 and 52 in the embodiment of FIGS. 2-12 could haveany one of many different constructions. For example, the anchors couldexpand by absorbing body fluid. The anchor 50, which is moved through apassage 40 in the embodiments of FIGS. 2-12, could mechanically expandupon exiting from the passage.

Positioning of Tubular Member

[0149] In the embodiment of the invention illustrated in FIG. 13, atubular member is positioned in the passage which extends through thebone. Since the embodiment of the invention illustrated in FIG. 13 isgenerally similar to the embodiments of the invention illustrated inFIGS. 1-12, similar numerals will be utilized to designate similarcomponents, the suffix letter “j” being associated with the numerals ofFIG. 13 to avoid confusion.

[0150] A bone 20 j which has been fractured is illustrated in FIG. 1.The bone 20 j is divided into two sections 22 j and 24 j by a fracture26 j. Opposite side surfaces 28 j and 30 j of the fracture 26 j arepressed together by bone securing assemblies 32 j.

[0151] It should be understood that the bone securing assemblies 32 jmay be utilized in the treatment of any one of many different types offractures. The fractures may or may not result in the formation of oneor more bone fragments. In FIG. 13, the bone securing assembly 32 j hasbeen illustrated as interconnecting sections 22 j and 24 j of a completebone fracture of the spiral type. However, the bone securing assemblies32 j could be utilized to connect a fragment of a bone to the mainportion of the bone from which the fragment was broken off.

[0152] The bone securing assembly 32 j (FIG. 13) includes a forcetransmitting member 38 j which extends across the fracture 26 j. Theforce transmitting member 38 j may be any one of many different types offorce transmitting members. The force transmitting member 38 j may beformed of human or animal body tissue. However, it is presentlypreferred to use a suture as the force transmitting member 38 j.Therefore, the force transmitting member 38 j will be referred to hereinas a suture.

[0153] The suture 38 j, that is, the force transmitting member, isdisposed in a straight cylindrical passage 40 j which extendsdiametrically across a generally cylindrical portion of the bone 20 j.The passage 40 j extends through hard compact tissue of an outer layer42 j of the bone and through spongy or cancellous bone tissue 44 j whichis enclosed by the hard outer layer. Although the passage 40 j has alinear configuration, the passage could have a nonlinear configurationif desired.

[0154] The suture 38 j extends between a first suture anchor 50 jdisposed on one side of the fracture 26 j and a second suture anchor 52j disposed on the opposite side of the fracture. Tension is maintainedin the suture 38 j to press the suture anchors 50 j and 52 j againstopposite sides of the bone 201 with a predetermined force. This forcepresses the side surfaces 28 j and 30 j of the fracture 26 j firmlytogether to promote healing of the fracture. If desired, buttons orother force distributing members could be provided between the anchors50 j and 52 j and the bone 20 j. Body tissue could be disposed betweenthe anchors 50 j and 52 j and the bone 20 j.

[0155] The suture 38 j and/or suture anchors 50 j and 52 j may be formedof any desired natural or artificial material. For example, the suture38 j may be formed of either a polymeric material or a metal. The suture38 j may be biodegradable. Any known suture material may be utilized toform the suture 38 j.

[0156] The suture anchors 50 j and 52 j have the same construction.However, the anchor 50 j could have a construction which is differentthan the construction of the anchor 52 j. The anchor 50 j has acylindrical outer side surface 56 j which extends between smooth roundedend portions 581 and 60 j. A pair of parallel cylindrical openings 64 jand 66 j extend diametrically through the anchor 50 j. The anchor 50 jis free of sharp corners or projections to avoid cutting or abrading ofbody tissue disposed adjacent to the anchor.

[0157] The suture anchor 50 j is made of a biocompatible material.Suitable materials include stainless steel or titanium, cobalt chromeand other biocompatible metals. Polymeric material may also be used,suitable polymeric materials includes polyethylene, polypropylene, andbiodegradable material such as PLA and PGA. It is believed that it maybe preferred to form the suture anchors 50 j and 52 j from biodegradableor bioerodible copolymers. If desired, the anchor 50 j could be formedof body material or hydrophilic materials.

[0158] It is contemplated that the anchor 50 j may have any desiredconfiguration. For example, the anchor 50 j could have any one of theconfigurations disclosed in U.S. Pat. No. 5,522,846 issued Jun. 4, 1996and entitled “Suture Anchor”. Alternatively, the suture anchor 50 jcould have the configuration disclosed in U.S. Pat. No. 5,534,012 issuedJul. 9, 1996 and entitled “Method and Apparatus for Anchoring a Suture”.

[0159] The cross-sectional size of the anchor 50 j may be such as toenable the anchor to be moved through the passage 40 j. However, theanchor 50 j could have a size and configuration which would preventmovement of the anchor 50 j through the passage 40 j. For example, theanchors 50 j and 52 j could have the same construction as the retainer92 of FIG. 3.

[0160] The length of the anchor 50 j is such as to enable it to span anopening at an end of the passage 40 j and transmit force from the suture38 j to a substantial area on the outer layer 42 j of the bone 20 j. Thelength of the anchor 50 j may be approximately three times the diameterof the anchor. It is believed that it will be preferred to form theanchor 50 j in such a manner as to eliminate any sharp corners orprojections.

[0161] In the illustrated embodiment of the invention, the anchor 50 jhas a cylindrical configuration. This particular anchor has an axiallength of about two millimeters and a diameter of about one millimeter.The openings 64 j and 66 j have a diameter of about one-half millimeter.

[0162] It should be understood that the foregoing dimensions have beenset forth herein for purposes of clarity of description and it iscontemplated that the size of the anchor 50 j may vary as a function ofthe size of the bone being treated. Thus, relatively small anchors maybe used in association with treatment of small bones in a wrist, hand,foot or ankle of a patient. Relatively large anchors may be used inassociation with treatment of larger bones in an arm, shoulder, leg orhip of a patient. It should be understood that the bone securingassembly 32 j may be used in conjunction with many different bones otherthan the specific bones previously mentioned.

[0163] Only a single anchor 50 j or 52 j has been shown at opposite endsof the passage 40 j. It is contemplated that a plurality of anchorscould be provided at each end of the passage 40 j. For example, a pairof separate or interconnected anchors could be provided in a mannersimilar to that disclosed in the aforementioned U.S. Pat. No. 5,534,012.

[0164] In the embodiment of the invention illustrated in FIG. 13, thesuture 38 j has a pair of limbs or sections 72 j and 74 j which extendthrough the openings 64 j and 66 j in the suture anchors 50 j and 52 j.A connector section 76 j interconnects the two limbs 72 j and 74 j ofthe suture 38 j and engages a portion of the anchor 50 j. A knot 78 j isformed in the opposite ends of the limbs 72 j and 74 j to interconnectthe two limbs of the suture 38 j.

[0165] When the knot 78 j is formed, a predetermined tension is presentin the limbs 72 j and 74 j of the suture 38 j. This results in thesuture anchors 50 j and 52 j being pressed firmly against the bone 20 jwith a predetermined force. This predetermined force is maintainedduring and after tying of the knot 78 j.

[0166] When the bone securing assembly 32 j is to be used to treat thefracture 26 j in the bone 20 j, the two sections 22 j and 24 j of thebone are pressed together at the fracture 26 j to align the sidesurfaces 28 j and 30 j of the fracture. A drill is then used to form thepassage 40 j which extends diametrically through the generallycylindrical bone 20 j. Of course, the passage 40 j could be formed bythe use of a tool other than a drill. If desired, the passage 40 j couldhave a noncircular cross-sectional configuration.

[0167] Once the passage 40 j has been formed in the two sections 22 jand 24 j of the bone 20 j, a tubular cylindrical member 240 is insertedinto the passage 40 j and extends diametrically through the bone 20 j.The leading end 242 of the tubular cylindrical member 240 is alignedwith a circular outlet 84 j from the passage 40 j. The opposite ortrailing end 244 of the tubular member is aligned with a circular inlet86 j to the passage 40 j. The tubular member 240 has a thin cylindricalwall which engages the sections 22 j and 24 j of the bone 201. Acylindrical inner side surface of the tubular member 240 defines acylindrical passage having a diameter which is only slightly less thanthe diameter of the passage 40 j.

[0168] The leading end 242 of the tubular member 240 is disposed in thecompact outer layer 42 j of the bone 20 j. Similarly, the trailing end244 of the tubular member 240 is disposed in the compact outer layer 42j of the bone 20 j. The tubular member 240 extends across the fracture26 j and stabilizes the two sections 22 j and 24 j of the bone 20 j.Since the opposite end portions of the tubular member 240 are disposedin the compact outer layer 42 j of the bone 20 j, the tubular member issolidly supported and holds the two sections 22 j and 24 j of the bone20 j in alignment at the fracture 26 j.

[0169] The opposite ends 242 and 244 of the tubular member 240 areaxially spaced from a generally cylindrical outer side surface 250 onthe bone 20 j. This enables the anchors 50 j and 52 j to be pressedagainst the outer side surface 250 of the bone 20 j. Therefore, tensionforces in the suture 38 j are transmitted through the anchors 50 j and52 j to the bone 20 j.

[0170] By inserting the tubular member 240 into the passage 40 j, theportions of the passage disposed on opposite sides of the fracture 26 jare maintained in alignment. The tubular member 240 may be flexible toenable the tubular member to be inserted into a nonlinear passage 40 jthrough the bone 20 j. The tubular member 240 may be formed of metal ora polymeric material. If the tubular member 240 is formed of a polymericmaterial, it may be preferred to form the tubular member from abiodegradable or bioerodible copolymer.

[0171] In accordance with one of the features of this embodiment of theinvention, the tubular member 240 is formed of bone. By forming thetubular member 240 of bone, tissue growth into the tubular member ispromoted. The tubular member 240 may be packed with bone or bone graft.The tubular member 240 may contain bone osteoinductive protein (BMP).Bone growth inducing materials containing apatite compositions withcollagen and/or other materials may be utilized. The tubular member 240may be formed of either human or animal bone.

[0172] It is contemplated that it may be preferred to form the tubularmember 240 of freeze dried human bone obtained from a cadaver. Thefreeze dried bone will absorb body fluids. As this occurs, the tubularmember 240 will expand and grip the two sections 22 j and 24 j of thebone 20 j. The body fluids will be conducted into bone growth promotingmaterials contained in the tubular member 240. If desired, antibioticsand/or other medicants may be provided in the bone or bone graft withwhich the tubular member 240 is packed. Of course, the tubular member240 may be formed of other materials, such as biodegradable materials,if desired.

[0173] The suture 38 j is formed into a loop which extends through theopenings 64 j and 66 j in the anchor 50 j. At this time, the suture 38 jhas a length which is substantially greater than the length illustratedin FIG. 2. The cylindrical anchor 50 j, with the suture 38 j connectedthereto, is then positioned in axial alignment with the tubular member240 which extends through the passage 40 j. Thus, the anchor 50 j ismoved to an orientation in which a longitudinal central axis of theanchor is coincident with the longitudinal central axis of thecylindrical passage 246 in the tubular member 240 which extends throughthe passage 40 j in the bone 20 j.

[0174] The leading end 58 j of the anchor 50 j is then moved into thecylindrical tubular member 240 which forms a liner for the passage 40 j.A pusher member pushes the anchor 50 j from an upper (as viewed in FIG.13) end 244 of the tubular member 240 along the passage 246 in thetubular member 240 and the passage 40 j in the bone 20 and through theoutlet 84 j from the passage. As the anchor 50 j moves through thepassages 40 j and 246, the suture 38 j is pulled through the passages bythe anchor.

[0175] The orientation of the anchor 50 j is then changed from anorientation in which the longitudinal central axis of the anchor 50 j isaligned with the coincident longitudinal central axes of the passages 40j and 246 to an orientation in which the longitudinal central axis ofthe anchor 50 j extends generally perpendicular to the longitudinalcentral axis of the passages 40 j and 246, i.e., the orientation shownin FIG. 13. To pivot the anchor 50 j to the orientation shown in FIG.13, as the anchor emerges from the outlet 84, the suture 38 j istensioned. The combination of the tension in the suture 38 j and forceapplied against the trailing end 60 j of the anchor 50 j by the pushermember causes the anchor to pivot about the trailing end 60 j of theanchor. The pusher member is then withdrawn and the suture 38 jtensioned to move the anchor to the position shown in FIG. 13 in amanner similar to that described in the aforementioned U.S. Pat. Nos.5,527,343 and 5,534,012.

[0176] Although it is believed that it may be preferred to change theorientation of the anchor 50 j after it has emerged from the passages 40j and 246, the anchor could be blocked from reentering the passage inother ways if desired. Thus, the anchor could expand after emerging fromthe passages 40 j and 246. This could be accomplished by having springbiased arms held in a retracted position by engagement of spring biasedarms with the inner side surface of the tubular cylindrical member 240which lines the passage 40 j. Upon emerging from the passages 40 j and246, the arms would move outward under the influence of spring forcesand extend radially outward beyond the edge of the exit from the passage40 j. If desired, the anchor 50 j could be constructed so as to expandin a manner similar to that disclosed in U.S. Pat. No. 5,397,331 and/orU.S. Pat. No. 4,409,974.

[0177] Rather than expanding under the influence of stored energy, suchas spring force, the anchor 50 j could expand by absorbing body fluids.Thus, the anchor 50 j may be compressed when it moves through thepassages 40 j and 246 and will expand and absorb body fluids afteremerging from the passages 40 j and 246. It is contemplated that theanchor 50 j could be constructed so as to expand in any one of the waysdisclosed in U.S. patent application Ser. No. 08/699,553 filed Aug. 19,1996 by Peter M. Bonutti and entitled “Suture Anchor”.

[0178] Once the anchor 50 j has been moved through the passage 246, thepassage is packed with bone particles and/or bone graft. The boneparticles and/or bone graft contains bone growth inducing materials. Inaddition, the bone particles and/or bone graft may contain medicinalsubstances along with osteoinductive protein.

[0179] The limbs 72 j and 74 j of the suture 38 j are then threadedthrough openings 64 j and 66 j in the second suture anchor 52 j. Thelimbs 72 j and 74 j of the suture 38 j are tensioned and the secondanchor 52 j is pressed against the outer side surface 250 of the bone 20j. While a predetermined tension force is maintained in the limbs 72 jand 74 j of the suture 38 j, the knot 78 j is tied in the suture tointerconnect the two suture anchors 50 j and 52 j with the suture 38 j.The suture 38 j is then trimmed to the desired length.

[0180] Once the knot 78 j has been tied between the limbs 72 j and 74 jof the suture 38 j, the tension in the suture 38 j presses the sidesurfaces 28 j and 30 of the fracture 26 j together. This pressurebetween the side surfaces 28 and 30 j of the fracture 26 j is maintainedby the suture 38 and suture anchors 50 j and 52 j until the fractureheals. It is believed that it may be preferred to form the suture 38 jand suture anchors 50 j and 52 j of a biodegradable material which,after the fracture 26 j has healed, will dissolve in the patient's body.

[0181] The cylindrical tubular member 240 which is inserted into thepassage 40 j through the bone 20 j performs the dual functions of liningthe inside of the passage 40 j and maintaining the two sections 22 j and24 j of the bone in alignment. The cylindrical tubular member 240 couldhave a slot formed in a side wall of the tubular member to facilitateinsertion of the tubular member into the passage 40 j. It iscontemplated that the cylindrical tubular member 240 could be left inthe passage 40 j after the bone securing assembly 32 j has beeninstalled. If the slotted or unslotted cylindrical tubular member 240 isto be left in the passage 40 j, the cylindrical tubular member 240 maybe formed of a biodegradable or bioerodible copolymer. When thecylindrical tubular member remains in the passage 40 j, the suture 38 jextends through the tubular member.

[0182] Although only a knot 78 j has been shown in FIG. 13 adjacent tothe second anchor 52 j, a suture retainer could be provided to furtherhold the limbs 72 j and 74 j of the suture 38 j. If a suture retainer isto be used in association with the knot 78 j, the suture retainer willbe moved along the limbs of the suture 38 j toward the knot before thelimbs 72 j and 74 j of the suture are trimmed to the short length shownin FIG. 13. The suture retainer would then be plastically deformed togrip the limbs 72 j and 74 j of the suture 38 j. Thereafter, the suturelimbs 72 j and 74 j would be trimmed to a desired length.

[0183] Although it is preferred to use a suture as the forcetransmitting member 38 j, it should be understood that the anchors 50 jand 52 j could be interconnected by other force transmitting members,such as a rod formed of bone. Although the anchors 50 j and 52 j haveconstructions which enable them to be used with a suture, the anchorscould be constructed so as to be used with other types of forcetransmitting members. For example, the anchors 50 j and 52 j could havethread convolutions to engage thread convolutions on a forcetransmitting member formed by a rod.

[0184] In the embodiment of the invention illustrated in FIG. 13, themember 240 is tubular. However, it is contemplated that a solid membercould be used to transmit force to bone on opposite sides of thefracture 26 j. Thus, the member 240 could be a solid cylindrical memberformed of bone. The cylindrical member may be formed of freeze driedbone.

[0185] When the member 240 is a solid member, the suture or other forcetransmitting member 38 j is eliminated. The solid member formed of bonebecomes the force transmitting member. Anchors, corresponding to theanchors 50 j and 52 j, are connected to opposite ends of the solidmember 240 formed of bone. The anchors may have internal threadconvolutions which engage external thread convolutions on the solidmember 240 formed of bone. Of course, other known connectors could beutilized to connect anchors with opposite ends of the solid member 240formed of bone.

NONLINEAR SUTURE PASSAGE—TUBULAR MEMEBER

[0186] In the embodiment of the invention illustrated in FIG. 13, thepassage 40 j through which the suture 38 j extends has a linearconfiguration. In the embodiment of the invention illustrated in FIG.14, the passage through which the suture extends has a nonlinearconfiguration. Since the embodiment of the invention illustrated in FIG.14 is generally similar to the embodiment of the invention illustratedin FIGS. 1-13, similar numerals will be utilized to identify similarcomponents, the suffix letter “k” being associated with the componentsof the embodiment of the invention illustrated in FIG. 14 to avoidconfusion.

[0187] A bone 20 k as a fracture 26 k which divides the bone into twosections 22 k and 24 k. Opposite side surfaces 28 k and 30 k of thefracture 26 k are pressed together by a bone suture assembly 32 k. Thebone suture assembly 32 k includes a suture 38 k which extends betweenfirst and second suture anchors 50 k and 52 k.

[0188] The suture 38 k is disposed in a passage 40 k having a nonlinearconfiguration. Thus, the passage 40 k includes a first section 140 kwhich is skewed relative to a second section 142 k of the passage 40 k.A bend 144 k is formed in the passage 40 k at an intersection 146 k ofthe first and second sections 140 k and 142 k of the passage 40 k. Theflexible suture 38 k extends around the bend 144 k along a nonlinearpath between the suture anchors 50 k and 52 k. At the bend 144 k, thesuture 38 k applies force against the section 24 k of the bone 20 kurging the section 24 k toward the left (as viewed in FIG. 5). Thisforce presses the sections 22 k and 24 k of the bone 20 k firmlytogether at the fracture 26 k.

[0189] The suture anchors 50 k and 52 k have the same cylindricalconstruction as the suture anchors 50, 52, 50 j and 52 j in theembodiment of the invention illustrated in FIGS. 2 and 13. A knot 78 k(FIG. 14) is provided between limbs of the suture 38 k to maintain adesired tension in the suture 38 k. This tension pulls the sutureanchors 50 k and 52 k toward each other. In addition, this tensionpresses the section 24 k of the bone 20 k firmly against the section 22k of the bone at the fracture 26 k.

[0190] The first section 140 k of the passage 40 k is formed at an angleto and extends through a longitudinal central axis of the generallycylindrical bone 20 k. The second section 142 k of the passage 40 k isformed in a direction perpendicular, i.e., along a radius, of thegenerally cylindrical bone 20 k. The two sections 140 k and 142 k of thepassage 40 k terminate in the spongy cancellous bone tissue 44 k.

[0191] When the suture assembly 32 k is to be used to treat the fracture26 k in the bone 20 k, the two sections 22 k and 24 k of the bone arepressed together at the fracture 26 k to align the side surfaces 28 kand 30 k of the fracture. A drill or other hole forming apparatus isthen used to form the first section 140 k of the passage 40 k. The drillor other hole forming apparatus is then used to form the second section142 k of the passage 40 k. When the second section 142 k of the passage40 k intersects the first section 140 k of the passage 40 k, formationof the section 142 k of the passage 40 k is interrupted.

[0192] Once the nonlinear passage 40 k has been formed in the twosections 22 k and 24 k of the bone 20 k, a tubular cylindrical liner 240k is inserted into the passage 40 k. The tubular cylindrical liner 240 kis formed by two separate cylindrical tubular members 252 and 254 whichare inserted at opposite ends of the passage 40 k. Alternatively, thetubular cylindrical liner 240 k may be formed by a single flexibletubular member which is inserted into the section 140 k of the passage40 k and then moved around the bend 144 k into the section 142 k of thepassage 40 k.

[0193] It is believed that it may be preferred to form the tubularmembers 252 and 254 of bone. The bone forming the tubular members 252and 254 may be either human or animal bone. The tubular members 252 and254 may be formed of freeze dried human bone.

[0194] The leading end 242 k of the tubular member 252 is disposed inthe compact outer layer 42 k of the bone 20 k. Similarly, the trailingend 244 k of the tubular member 254 is disposed in the compact outerlayer 42 k of the bone 20 k. The tubular member 252 extends across thefracture 26 k and stabilizes the two sections 22 k and 24 k of the bone20 k. Since the end portions 242 k and 244 k of the tubular members 252and 254 are disposed in the compact outer layer 42 k of the bone 20 k,the tubular members are solidly supported and hold the two sections 22 kand 24 k of the bone 20 k in alignment at the fracture 26 k.

[0195] The opposite ends 242 k and 244 k of the tubular members 252 and254 are axially spaced from a generally cylindrical outer side surface250 k on the bone 20 k. This enables the anchors 50 k and 52 k to bepressed against the outer side surface 250 k of the bone 20 k.Therefore, tension forces in the suture 38 k are transmitted through theanchors 50 k and 52 k to the bone 20 k.

[0196] The cylindrical anchor 50 k, with the suture 38 k connectedthereto, is then positioned in axial alignment with the section 142 k ofthe passage 40 k. The leading end 58 k of the anchor 50 k is then movedinto the section 142 k of the passage 40 k lined by the tubular member254. A flexible pusher member applies force against the trailing end 60k of the anchor 50 k and pushes the anchor around the bend 144 k andthrough the section 140 k of the passage 40 k lined by the tubularmember 252.

[0197] Alternatively, a flexible wire or other member could be insertedinto the section 140 k of the passage 40 k. The wire would move aroundthe bend 144 k and extend outward from the section 142 k of the passage.The wire would then be connected with the anchor 50 k and suture 38 k.The leading end 58 k of the anchor 50 k would then be inserted into thesection 142 k of the passage 40 k. Tension on the wire would pull theanchor 50 k around the bend 144 k and out of the section 140 k of thepassage 40 k.

[0198] The passages in the tubular members 252 and 254 may be packedwith bone particles and/or bone graft. Bone osteoinductive protein (BMP)may be provided in the tubular members. Antibiotics and/or othermedicants may be included along with collagen.

[0199] The suture 38 k is then threaded through openings in the sutureanchor 52 k. The suture 38 k is then tensioned and the second anchor 52k is pressed against the outer side surface of the bone 20 k. While apredetermined tension force is maintained in the suture 38 k, the knot78 k is tied.

[0200] In the illustrated embodiment of the invention, the two sections140 k and 142 k of the passage 40 k have a straight cylindricalconfiguration. However, it is contemplated that the sections 140 k and142 k of the passage 40 k could have a different configuration ifdesired. For example, the section 140 k and/or 142 k of the passage 40 kcould have a nonlinear central axis and could have a noncircularcross-sectional configuration of desired.

[0201] Body tissue, corresponding to the body tissue 132 of FIG. 4 couldbe disposed between the anchor 50 k and/or 52 k and the bone 20 k.Although the suture 38 k has been illustrated as having a pair of limbsor sections which extend between the anchors 50 k and 52 k, the suture38 k could have a single limb or section if desired. The anchor 50 ccould mechanically expand, by absorbing body liquid or under theinfluence of expansion springs, after the anchor has emerged from thepassage 40 k to prevent the anchor from being pulled back through thepassage.

Retainer and Tubular Member

[0202] In the embodiment of the invention illustrated in FIG. 13, a pairof suture anchors 50 j and 52 j are connected with the suture 38 j tomaintain tension in the suture and pressure against opposite sidesurfaces 28 j and 30 j of the fracture 26 j. In the embodiment of theinvention illustrated in FIG. 15, a suture retainer is used in place ofone of the suture anchors. Since the embodiment of the inventionillustrated in FIG. 15 is generally similar to the embodiment of theinvention illustrated in FIG. 13, similar numerals will be utilized todesignate similar components, the suffix letter “m” being associatedwith the embodiment of the invention illustrated in FIG. 15 to avoidconfusion.

[0203] A bone 20 m has sections 22 m and 24 m which are separated by afracture 26 m. The fracture 26 m has side surfaces 28 m and 30 m whichare pressed together by a bone suture assembly 32 m. A suture 38 mextends through a cylindrical passage 40 m which extends diametricallythrough the generally cylindrical bone 20 m. The suture 38 m has a pairof limbs or sections 72 m and 74 m which are connected with a sutureanchor 50 m. The suture anchor 50 m has the same construction as thesuture anchor 50 of FIG. 2.

[0204] Once the passage 40 has been formed in the two tubular sections22 m and 24 m of the bone 20 m, a tubular cylindrical member 240 m isinstalled into the passage 40 m and extends diametrically through thebone 20 m. The leading end 242 m of the cylindrical member 240 m isaligned with a circular outlet 84 m from the passage 40 m. The oppositeor trailing end 244 m of the tubular member 240 m is aligned with acircular inlet 86 m to the passage 40 m.

[0205] The tubular member 240 m has a thin cylindrical wall whichengages the sections 22 m and 24 m of the bone 20 m. A cylindrical innerside surface of the tubular member 240 m defines a cylindrical passage246 m having a diameter which is only slightly less than the diameter ofthe passage 40 m. The tubular member 240 m is formed of bone.Alternatively, the tubular member 240 m could be formed of abiodegradable material.

[0206] The leading end 242 m of the tubular member 240 m is disposed inthe compact outer layer 42 m of the bone 20 m. Similarly, the trailingend 244 m of the tubular member 240 m is disposed in the compact outerlayer 42 m of the bone 20 m. The tubular member 240 m extends across thefracture 26 m and stabilizes the two sections 22 m and 24 m of the bone20 m. Since the opposite end portions of the tubular member 240 m aredisposed in the compact outer layer 42 m of the bone 20 m, the tubularmember is solidly supported and holds the two sections 22 m and 24 m ofthe bone 20 m in alignment at the fracture 26 m.

[0207] The opposite ends 242 m and 244 m of the tubular member 240 m areaxially spaced from a generally cylindrical outer side surface 250 m onthe bone 20 m. This enables the anchors 50 m and 92 m to be pressedagainst the outer side surface 250 m of the bone 20 m. Therefore,tension forces in the suture 38 m are transmitted through the anchors 50m and 92 m to the bone 20 m.

[0208] The tubular member 240 m is formed of freeze dried human bone.The tubular member 240 m is packed with bone and/or bone graft. Thetubular member 240 m also contains bone osteoinductive protein (BMP).Suitable medicants may be provided in the tubular member 240 m.

[0209] A suture retainer 92 m is used in place of the suture anchor 52of FIG. 2. The suture retainer 92 m (FIG. 15) has a sphericalconfiguration. A cylindrical passage 94 m extends through the center ofthe spherical suture retainer 92 m. The sections 72 m and 74 m of thesuture 38 m extend around the spherical outer side surface of the sutureretainer 92 m. Thus, a loop is formed in each of the sections 72 m and74 m around portions of the suture retainer 92 m.

[0210] If desired, the suture retainer 92 m could have a differentconfiguration. For example, the suture retainer 92 m could have an ovalor elliptical configuration. Although the passage 94 m has a linearcentral axis, the passage could have a nonlinear central axis. Ifdesired, a plurality of passages having the same or differentconfigurations could be provided in the suture retainer 92 m.

[0211] After the suture 38 m has been inserted through the sutureretainer 92 m, the suture retainer 92 m is moved along the sections 72 mand 74 m of the suture 38 m toward the bone 20 m. The suture retainer 92m is formed as one piece of a polymeric material having a relatively lowcoefficient friction. Therefore, the two sections 72 m and 74 m of thesuture 30 m can readily slide along the surfaces of the suture retainer52 m while the suture retainer moves toward the bone 20 m.

[0212] A predetermined tension is maintained in the sections 72 m and 74m of the suture 38 m while the suture retainer 92 m is pressed againstthe bone 20 m. This results in the suture 38 m being pulled tightlyagainst the suture anchor 50 m. The tension in the suture 38 m iseffective to press the suture anchor 50 m and retainer 92 m againstopposite sides of the bone 20 m with a predetermined force.

[0213] While the sections 72 m and 74 m of the suture 38 m are beingtensioned with a predetermined force, the suture retainer 92 m isplastically deformed in the same manner as previously described inconjunction with the embodiment of the invention illustrated in FIG. 3.To plastically deform the suture retainer 92 m, a plurality of forceapplying or clamp members are pressed against the suture retainer with apredetermined minimum force. The force applied against the sutureretainer 92 m by the force applying members is sufficient to causeplastic deformation of the material of the suture retainer.

[0214] The force is applied against the suture retainer 92 m while thesuture retainer is at a temperature which is below the transitiontemperature of the biodegradable polymer which forms the suture retainer92 m. Thus, the suture retainer 92 m is at approximately the sametemperature as the bone 20 m when the force is applied against thesuture retainer. The force causes the material of the suture retainer 92m to flow and grip the sections 72 m and 74 m of the suture 38 m.

[0215] The suture retainer 92 m may be formed of many differentmaterials. However, it is believed that it will be preferred to form thesuture retainer 92 m of a biodegradable polymer. One biodegradablepolymer which may be utilized is polycaperlactone. Alternatively, thesuture retainer 92 m could be formed of polyethylene oxide terephthalateor polybutylene terephthalate. It is also contemplated that otherbiodegradable or bioerodible copolymers could be utilized.

[0216] Although it is preferred to form the suture retainer 92 m of abiodegradable material, the suture retainer could be formed of amaterial which is not biodegradable. For example, the suture retainer 92m could be formed of an acetyl resin, such as “DELRIN” (trademark).Alternatively, the suture retainer 92 m could be formed ofpara-dimethylamino-benzenediaz-o sodium sulfonate, such as “DEXON”(trademark). The construction of the suture retainer 92 m and the mannerin which is cooperates with the suture 38 m is the same as is disclosedin U.S. patent application Ser. No. 08/905,084 filed Aug. 1, 1997 byPeter M. Bonutti et al. and entitled “Method and Apparatus for Securinga Suture”.

[0217] The suture retainer 92 m is plastically deformed to grip thelimbs 72 m and 74 m of the suture 38 m. However, the suture retainer 92m could be constructed so as to be mechanically actuated to grip thesuture 38 m. If desired, a combination of a mechanical gripping actionand plastic deformation could be utilized by a retainer to grip thesuture 38 m.

Conclusion

[0218] In view of the foregoing description, it is apparent that thepresent invention relates to a method of securing sections 22 and 24 ofa fractured bone 20. Sections 22 and 24 of a fractured bone 20 are heldagainst movement relative to each other by a force transmitting member,such as a suture 38, which extends through a passage 40 in the bone. Thepassage 40 in the bone may have a linear or nonlinear configuration.Tension is maintained in the force transmitting member 38 to presssurfaces 28 and 30 on the fracture together by securing anchors 50 and52 or suture retainers 92 to opposite ends of the force transmittingmember 38. It is believed that a suture 38 may advantageously be used asthe force transmitting member.

[0219] A tubular member 240 is positioned in a linear passage (FIGS. 13and 15) or a nonlinear passage (FIG. 14) through the bone 20. Thetubular member 240 extends into portions of the passage 40 on oppositesides of the fracture 26. End portions of the tubular member may bepositioned in a compact outer layer 42 of the bone. The tubular member240 may be formed of bone. The force transmitting member 38 may beformed of bone or other body tissue.

What is claimed is:
 1. A bone suture assembly for treating a fracture of a bone comprising: a first bone plate positioned proximate to the bone; and a suture positioned through the first bone plate and across the fracture of the bone to thereby stabilize the fracture.
 2. A bone suture assembly as defined in claim 1 further including a second bone plate positioned proximate to the bone generally opposite the first bone plate, wherein the suture is positioned through the second bone plate.
 3. A bone suture assembly as defined in claim 2 further including a passage through the bone and across the fracture, wherein the suture is disposed within the passage.
 4. A bone suture assembly as defined in claim 3 further including at least one fastener to hold the first bone plate to the bone.
 5. A bone suture assembly as defined in claim 4 wherein at least one fastener extends across the fracture of the bone.
 6. A bone suture assembly as defined in claim 5 wherein at least one fastener extends through the bone and through the second bone plate.
 7. A bone suture assembly as defined in claim 6 wherein at least one fastener includes a screw and nut.
 8. A bone suture assembly as defined in claim 1 further including a tubular member positioned through the bone and across the fracture, wherein the suture is disposed within the tubular member.
 9. A bone suture assembly as defined in claim 8 wherein the tubular member is packed with bone particles.
 10. A bone suture assembly as defined in claim 8 wherein the tubular member is packed with bone osteoinductive protein.
 11. A bone suture assembly as defined in claim 3 wherein the passage is nonlinear.
 12. A bone suture assembly as defined in claim 11 wherein at least one tubular member is disposed within the nonlinear passage and wherein the suture is disposed within at least one tubular member.
 13. A bone suture assembly for treating a fracture of a bone comprising: a first suture anchor positioned proximate to the bone; a first bone plate positioned between the first suture anchor and the bone; and a suture positioned across the fracture of the bone to stabilize the fracture, the suture having a first end portion disposed through the bone plate and attached to the first suture anchor.
 14. A bone suture assembly as defined in claim 13 further including a second suture anchor positioned proximate to the bone generally opposite the first suture anchor, the second suture anchor attached to a second end portion of the suture.
 15. A bone suture assembly as defined in claim 14 further including a second bone plate positioned between the second suture anchor and the bone.
 16. A bone suture assembly as defined in claim 15 further including a passage through the bone and across the fracture, wherein the suture is disposed within the passage.
 17. A bone suture assembly as defined in claim 16 further including at least one fastener to hold the first bone plate to the bone.
 18. A bone suture assembly as defined in claim 17 wherein at least one fastener extends across the fracture of the bone.
 19. A bone suture assembly as defined in claim 18 wherein at least one fastener extends through the bone and through the second bone plate.
 20. A bone suture assembly as defined in claim 19 wherein at least one fastener includes a screw and nut.
 21. A bone suture assembly as defined in claim 14 wherein the first and second suture anchors are suture retainers.
 22. A bone suture assembly as defined in claim 21 wherein the suture retainers include deformable material to hold the suture retainers to the suture.
 23. A method for treating a fracture of a bone comprising: positioning at least one suture anchor proximate to the bone; positioning at least one bone plate between at least one suture anchor and the bone; moving at least one suture across the fracture of the bone and through at least one bone plate; attaching at least one suture to at least one suture anchor; and tensioning at least one suture to stabilize the fracture of the bone.
 24. A method as defined in claim 23 wherein at least one suture anchor is a suture retainer.
 25. A method as defined in claim 23 further including fastening at least one bone plate to the bone with at least one screw.
 26. A method as defined in claim 25 wherein at least one screw has a length less than a diameter of the bone.
 27. A method as defined in claim 25 wherein at least one screw has a length greater than a diameter of the bone.
 28. A method as defined in claim 27 wherein at least one screw includes at least one nut.
 29. A method as defined in claim 28 wherein at least one screw extends across the fracture of the bone.
 30. A method as defined in claim 23 further including forming at least one passage through the bone, and wherein moving at least one suture includes moving at least one suture through at least one passage.
 31. A method as defined in claim 30 wherein attaching at least one suture to at least one suture anchor is performed prior to moving at least one suture, and wherein moving at least one suture includes moving at least one suture attached to at least one suture anchor through at least one passage.
 32. A method as defined in claim 31 further including changing the orientation of at least one suture anchor from a first to a second configuration thereby causing at least one suture anchor to become proximate to the bone and impassable through at least one passage.
 33. A method as defined in claim 32 wherein tensioning at least one suture includes tensioning at least one suture between at least two suture anchors to stabilize the fracture of the bone. 